Individual
OTAR MICHAEL TAKTAKISHVILI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
259 1ST ST, EMERGENCY DEPARTMENT, MINEOLA, NY 11501-3957
(516) 663-2727
(516) 663-2727
Mailing address
259 1ST ST, EMERGENCY DEPARTMENT, MINEOLA, NY 11501-3957
(516) 663-2727
(516) 663-2727
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
054323
CT
207P00000X
Emergency Medicine Physician
260699
NY
Other
Enumeration date
05/20/2008
Last updated
08/19/2015
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